Provider Demographics
NPI:1508383449
Name:CHURCH, KATHLEEN MAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MAY
Last Name:CHURCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1911
Mailing Address - Country:US
Mailing Address - Phone:585-412-9149
Mailing Address - Fax:
Practice Address - Street 1:181 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1911
Practice Address - Country:US
Practice Address - Phone:585-412-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor